Using flowable gelatin in anterior cervical spine surgery in real-world practice: a retrospective cohort study

Wu, Yamei; Wu, Yiqing; Gangoli, Gaurav; Bourcet, A.; Danker, Walter; Gong, Q.; Han-hui, Zhan; Chen, Wendong; Wang, Zheng

doi:10.2217/cer-2018-0121

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…For example, vertebral arteries and surrounding veins can be sources of intractable bleeding, and continuous oozing from the vertebral foramens is frequently encountered, making conventional hemostatic techniques the suboptimal solution. The advantages of TGM in cervical spine procedures have previously been advocated, and the usage of these potent hemostatic agent can be justified, regardless of the actual volume of blood loss [ 3 , 22 ]. Several previous studies have indicated that incidental durotomy was associated with increased blood loss [ 23 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study

Kato

Miyahara²,

Matsubayashi³

et al. 2023

BMC Musculoskelet Disord

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Study design A prospective cohort study. Objectives Thrombin-gelatin matrix (TGM) is a rapid and potent hemostatic agent, but it has some limitations, including the cost and its preparation time. The purpose of this study was to investigate the current trend in the use of TGM and to identify the predictors for TGM usage in order to ensure its proper use and optimized resource allocation. Methods A total of 5520 patients who underwent spine surgery in a multicenter study group within a year were included in the study. The demographic factors and the surgical factors including spinal levels operated, emergency surgery, reoperation, approach, durotomy, instrumented fixation, interbody fusion, osteotomy, and microendoscopy-assistance were investigated. TGM usage and whether it was routine or unplanned use for uncontrolled bleeding were also checked. A multivariate logistic regression analysis was used to identify predictors for unplanned use of TGM. Results Intraoperative TGM was used in 1934 cases (35.0%), among which 714 were unplanned (12.9%). Predictors of unplanned TGM use were female gender (adjusted odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.02–1.43, p = 0.03), ASA grade ≥ 2 (OR: 1.34, 95% CI: 1.04–1.72, p = 0.02), cervical spine (OR: 1.55, 95% CI: 1.24–1.94, p < 0.001), tumor (OR: 2.02, 95% CI: 1.34–3.03, p < 0.001), posterior approach (OR: 1.66, 95% CI: 1.26–2.18, p < 0.001), durotomy (OR: 1.65, 95% CI: 1.24–2.20, p < 0.001), instrumentation (OR: 1.30, 1.03–1.63, p = 0.02), osteotomy (OR: 5.00, 2.76–9.05, p < 0.001), and microendoscopy (OR: 2.24, 1.84–2.73, p < 0.001). Conclusions Many of the predictors for unplanned TGM use have been previously reported as risk factors for intraoperative massive hemorrhaging and blood transfusion. However, other newly revealed factors can be predictors of bleeding that is technically challenging to control. While routine usage of TGM in these cases will require further justification, these novel findings are valuable for implementing preoperative precautions and optimizing resource allocation.

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Section: Discussionmentioning

confidence: 99%

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study

Kato

Miyahara²,

Matsubayashi³

et al. 2023

BMC Musculoskelet Disord

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“…The advantages of TGM in cervical spine procedures have previously been advocated, and the usage of these potent hemostatic agent can be justi ed, regardless of the actual volume of blood loss. [12,21] Several previous studies have indicated that incidental durotomy was associated with increased blood loss. [22][23][24][25] This may be due in part to the prolonged operation time needed for dural repair, but other authors have reported that the loss of expansive tension of the dural sac due to cerebrospinal uid leakage leads to the dilatation of the epidural venous plexus, [26] which can result in increased blood loss, necessitating unplanned TGM usage.…”

Section: Discussionmentioning

confidence: 99%

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: A multicenter observational study

Kato

Miyahara

Matsubayashi

et al. 2022

Preprint

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Study design. A prospective cohort study. Objectives. Thrombin-gelatin matrix (TGM) is a rapid and potent hemostatic agent, but it has some limitations, including the cost and its preparation time. The purpose of this study was to investigate the current trend in the use of TGM and to identify the predictors for TGM usage in order to ensure its proper use and optimized resource allocation. Methods. A total of 5520 patients who underwent spine surgery in a multicenter study group within a year were included in the study. The demographic factors and the surgical factors including spinal levels operated, emergency surgery, reoperation, approach, durotomy, instrumented fixation, interbody fusion, osteotomy, and endoscopy were investigated. TGM usage and whether it was routine or unplanned use for uncontrolled bleeding were also checked. A multivariate logistic regression analysis was used to identify predictors for unplanned use of TGM. Results. The mean age was 63.5 years old, and males accounted for 59.9% of patients. The mean operation time was 147 minutes, median blood loss was 50mL, and interquartile range was 145mL. Intraoperative TGM was used in 1934 cases (35.0%), among which 714 were unplanned (12.9%). Predictors of unplanned TGM use were female gender, cervical spine, tumor, posterior approach, durotomy, instrumentation, osteotomy, and endoscopy. Conclusions. Many of the predictors for unplanned TGM use have been previously reported as risk factors for intraoperative massive hemorrhaging and blood transfusion. However, other newly revealed factors can be predictors of bleeding that is technically challenging to control.

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“…Therefor, nding a convenient, fast and effective hemostatic tool is extremely important. Gelatin matrix hemostatic sealant can signi cantly reduce blood loss by promoting coagulation and brin formation [9] . These agents are a mixture of a owable gelatin matrix (bovine or porcine) and a human-derived thrombin component.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of thrombin-based flowable hemostatic agents in spine surgery: a protocol for systematic review and meta- analysis

YangMasood

Zhang

et al. 2023

Preprint

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Introduction As hemostasis is a complex process that bleeding can be difficult to control, higher requirements are needed for spinal surgeons in intraoperative hemostasis. Floseal and Surgiflo are two common thrombin-based flowable hemostatic agents. Nevertheless, Floseal or Surgiflo has not been universally recommended by the current guidelines of preoperative hemostatic management in spine surgery due to lack of relative systematic evidence-based medical evidence. Moreover, adverse effects of novel absorbable hemostatic biomaterial may be poorly reported and inconsistently described. Meanwhile, there is currently no systematic review and meta-analyses available which sum up the existing evidence. Our study aims to explore the efficacy and safety of thrombin-based flowable hemostatic agents in spine surgery, and to provide corresponding evidence-based medical evidence. Methods and analysis Our study will conduct a systematic review and meta-analysis to explore the efficacy and safety of thrombin-based flowable hemostatic agents in spine surgery, based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P). Two authors will retrieve the relevant articles using the eight databases (PubMed, Scopus, Embase, Cochrane Library, Web of Science, CNKI, Wanfang and CBM) from inception to 16st Aug, 2022. Three authors will screen citation titles and abstracts and evaluated full-text of each potentially relevant citation, and then extract the data using a data extraction form. Any discrepancies in decisions between reviewers will be resolved through discussion. All included studies will be evaluated for quality and risk of bias according to the Cochrane guidelines. A subgroup analysis and a sensitivity analysis will be used to find the main source of between-study heterogeneity. All data analysis will be performed using RevMan v.5.3 Software provided by the Cochrane Collaboration.

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Using flowable gelatin in anterior cervical spine surgery in real-world practice: a retrospective cohort study

Cited by 4 publications

References 17 publications

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study

Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: A multicenter observational study

The efficacy and safety of thrombin-based flowable hemostatic agents in spine surgery: a protocol for systematic review and meta- analysis

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